Picture being 45 years old, relatively healthy and fit. But during the last 6 months, things have become different. You are more tired, anxious and nervous. Small things which didn't bother you before are now annoying. Foods which never troubled your stomach cause pain. Sometimes you feel overheated and cold all at once. When other people turn up the heat, you feel compelled to remove a layer of clothing. You look in the mirror and the "plumpness" from your face has disappeared. You are, in a word, "peri-menopausal"-- around menopause.

A Natural Process
While every woman is different, the beginning of menopause commonly occurs between the ages of 42 and 55. In the five to ten years prior to menopause, the ovaries become less sensitive to hormonal signals which stimulate estrogen and progesterone. And although there are still about 10,000 immature follicles left in the ovaries, they fail to mature. Because the ovaries do not produce consistent amounts of hormones, the menstrual cycle becomes irregular. Eventually, the ovaries stop producing enough of the estrogen hormone, periods cease, and menopause arrives.

The Transition of a Lifetime
For a woman, menopause is perhaps the most crucial transition she will experience in her life. Approximately 1.3 million women reach menopause each year, and that number will double by the year 2010, when 60 million women will be close to, or complete with, the transition of menopause (1). Although most women will experience some symptoms, they may be quite varied. Between 50% and 80% of women experience hot flashes, lasting two to three minutes, during the first several years of menopause. Women may also notice increasing fatigue, nervousness, insomnia, palpitation and emotional stress. Some sources include depression, although thankfully no studies objectively support that menopausal women suffer from it any more than the rest of society. Research indicates that women (as well as men) are more likely to experience depression in their twenties and thirties than in mid-life (2).

Estrogen Therapy--Is It For You?
About 95% of women in the Western nations spend approximately one-third of their lives in a state of estrogen deficiency. It is estimated that today as many as 30% of these women seek out some kind of estrogen replacement therapy (ERT). ERT has been used to alleviate hot flashes, night sweats, depression and anxiety. It is also recommended for prevention of cardiovascular disease and osteoporosis in menopausal and post-menopausal women. In the United States, estrogen is commonly taken in doses ranging from .3 milligrams to 1.25 milligrams for the first 25 days of the month. Oftentimes, progestin is added for days 16-25 in doses of 2.5-10 milligrams. Some women have opted for the skin patch, which is applied once each week. Many women with symptoms who are also interested in taking the least amount of estrogen possible, have opted to take their estrogen every other day.

As most women know, choosing estrogen replacement therapy is not an easy decision, even if it does alleviate some menopausal symptoms. Results from several studies indicate that ERT provides some health benefits for women who have entered menopause. It reduces risk of death from coronary disease by 40% and risk of hip fracture by as much as 60%. However, the same studies show that this therapy also increases the risk of cancer in the uterus and the breast (3).

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